CIGNA Behavioral Health Practitioner Connection – TELEPHONE AND APPOINTMENT ACCESS

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The Practitioner Conection
Volume XXIX, 1st Quarter

The right help at the right time!

TELEPHONE AND APPOINTMENT ACCESS

Automated system reports are used to continuously monitor responsiveness to callers on both Intake and Crisis lines to determine if individuals receive timely behavioral health and related services. Overall, behavioral telephone access goals had been met for several years. Then, in mid 2006, the percentage of calls answered within 30 seconds began a gradual downward trend and abandonment rates and average speed of answer began to rise during the fourth quarter of 2006, until goals were no longer being met.

A 2007 commitment to improvement began in earnest. Staffing was increased and patterns of misdirected calls were identified and addressed to maximize time intended for callers with access to care and service needs. Documentation requirements for calls were streamlined. Although improvement to goal was seen in the latter part of 2007 for Average Speed of Answer and for Abandonment Rates, desired overall improvement was not seen for annual speed of answer or for the percentage of calls answered within timeframe. Unexpectedly high volume existed for incoming calls and fewer people were taking advantage of Open Access, a model that allows individuals seeking routine outpatient care with contracted network professionals to do so without seeking pre-authorization.

To improve 2008 responsiveness to the people we serve, CIGNA reorganized behavioral staff resources, creating dedicated teams. One team focused exclusively on calls from individuals seeking services, and a second on response to calls from facilities and network professionals. A Six Sigma study drove statistically significant improvement in the rate for first call resolution of caller issues and a Kaizen Event drove best practices to reduce rates for call handling time and speed of call transfer, when required. The following table presents the three year change in key behavioral telephone access performance metrics nationally.

Results	2006	2007	2008	Goal
Speed of Answer	25 seconds	37 seconds	19 seconds	30 seconds or less
% of Calls Answered within 30 seconds	72%	63%	78%	80% or greater
Abandonment Rate	3.7%	4.8%	2.7%	Under 5%

Improvement opportunity continues in 2009 for the percentage of calls answered within 30 seconds, and to better support people who might choose to use CIGNA's Web-based behavioral directory of contracted network professionals to access routine outpatient care independently.

2008 Appointment Access Performance:
As a critical component of healthcare service and quality, speed of access to care is measured in relation to urgency of care need, and is a strong predictor of overall individual satisfaction. Although there was no statistically significant change in any of the 2008 rates for access, CIGNA has strengthened behavioral response capabilities in several ways:
• Expanded the intermediate care network by 49.5% in 2007 and by 33% in 2008 to improve access for urgent care.
• Expanded the crisis stabilization network by 22.3% in 2007 and by 12% in 2008 to improve access for emergent care.
• Increased the number of psychiatrists and therapists who can perform medication evaluation and management.
• Increased the number of nurse practitioners by 3.6% in 2007 and by 7.6% in 2008. Psychiatrists increased by 2.5% in 2007 and by 6.5% in 2008.
• Encouraged specialty and diversity access through published articles in the E-Brief and National Network Newsletter, providing visibility to the importance of diversity, the use of Personal Self Introduction, and appointment access standards.

Appointment Access
Standard Name	Standard Measure	Goal	2008
Non-Life Threatening Emergency	Within 6 hours	100%	99.7%
Urgent	Within 48 hours	90%	98.5%
Routine	Within 10 working days	85%*	78%
Office Wait Times	15 minutes or less	80%*	83%

* Derived from the percent of ECHO Participant Satisfaction Survey responses of Always and Usually.

CIGNA measures access to care regularly, and implements efforts to improve ease of care access as appropriate. Individuals are encouraged to expedite access for routine care with network professionals by independently accessing care through the Online Directory at CIGNA's behavioral Web site, and network professionals are urged to develop informative Personal Self Introductions for the Web site that facilitate care access. Notation of access standards, and a reminder to call CIGNA for assistance in scheduling behavioral appointments to standard, is placed near the Online Provider Directory search function, and complements CIGNA staff's ability to assist individual access using specialty searches and to provide condition-specific educational materials.